乳頭部共通管に基部を有し胆管内へ進展したポリープ型十二指腸乳頭部腺腫内癌の1例 A case of polyp-type ampullary carcinoma-in-adenoma within the ampullary channel, displaying an intraductal growth pattern

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症例は70歳女性.閉塞性黄疸を契機に総胆管結石症と診断し,内視鏡的切石術を予定した.EST後,主乳頭部よりポリープ状腫瘤が露出し,十二指腸乳頭部腫瘍の診断で幽門輪温存膵頭十二指腸切除術を行った.病理学的には,病変は共通管部に基部を有する亜有茎性ポリープの肉眼的形態を示す腺腫内癌であった.十二指腸管腔側に露出せず,胆管内腔へ進展発育したまれなポリープ型十二指腸乳頭部腺腫内癌を経験したため,報告する.

A 70-year-old woman with jaundice was referred to our hospital. Obstructive jaundice caused by common bile duct (CBD) stones was diagnosed based on the results of blood tests, abdominal computed tomography, and endoscopic retrograde cholangiopancreatography. We attempted to remove the CBD stones endoscopically. After endoscopic sphincterotomy, a polypoid lesion was exposed at the ampulla of Vater. Histological examination of a biopsy specimen from the ampullary lesion revealed a tubular adenoma, and the patient underwent pylorus-preserving pancreatoduodenectomy. Pathological examination of the resected specimen revealed a polyp-type ampullary carcinoma-in-adenoma arising from the ampullary channel. Herein, we report a rare case of polyp-type ampullary carcinoma-in-adenoma displaying an intraductal growth pattern.

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  • 日本消化機病學會雜誌. 乙

    日本消化機病學會雜誌. 乙 112(8), 1517-1524, 2015

    The Japanese Society of Gastroenterology

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